Laserfiche WebLink
ZIP Code <br /> of Des DEWONATf;p UNOEROROUND gTp�OE TATA Manteca 95336 <br /> Flell@@ Jt)Aed UST�Perator Preao^D the Troinin AL <br /> INFORMMVON <br /> MaenO Mdrou Mail 9 f1'nrd ea s✓town on Me 1CC Ce <br /> p•O. sox- Lodi,ICC��been a CA.952q t <br /> 8032295 ICC C@Mflc810„E 209 6 <br /> Ilf. Expiration t]ate <br /> Individuals assuming the duties F---ITy EMPLOYEE INFORMATION 10/22/2024 <br /> facility employee duties.i of the facility emplo <br /> before Performing/aoll ndlvlduals ass tie betoro October 1J,2018 must be trained within JO days of performing <br /> tY emplo liming the duties o/the facility empioyee on and altar <br /> yee duffles <br /> Check Oehr pox —�-- Octobe►13,2018 must be trained <br /> all of the Information In rh sf t Me Indly/dual(s)tra/ned! ——— <br /> �— <br /> /s section. s appended to this form" The appended Nat;at a minimum,must co»ta/n <br /> Namo of Individual <br /> (a)Trained Date of Assuming <br /> f Initial Training Date ReaponsitNl as• <br /> r FaNlily Employ» <br /> ran � <br /> of p — <br /> r � <br /> r " <br /> f ECV IV. BY DESIGNATED UST OPERATOR <br /> The facility Di employees listed above have completed the required training In accord <br /> CONDUCTINGtyith CTHIS TRAINING <br /> fltle ZJ,DI on 3,Chapter 1g Sec <br /> n 2715(c)and all the Information provided herein is accurate, Code of Reg <br /> T " UST Oper r Signat ulatlorts, <br /> 1 Oate of Training <br /> CM2tadorna6nenrrricrhl �Da 10/11/2023 <br /> �' rd UST_ <br /> .unldocCodes.orgCa Lk-W�&-ageTar* <br /> 111-Rev.1010,118 <br /> f <br />